Alternative Names

Causes, incidence, and risk factors

Muscles, ligaments, and other structures hold the uterus in the pelvis. If these tissues are weak or stretched, the uterus drops into the vaginal canal. This is called prolapse.

This condition is more common in women who have had one or more vaginal births.

Other things that can cause or lead to uterine prolapse include:

Normal aging

Lack of estrogen after menopause

Conditions that put pressure on the pelvic muscles, such as chronic cough and obesity

Pelvic tumor (rare)

Repeated straining to have a bowel movement due to long-term constipation can make the problem worse.

Symptoms

Pressure or heaviness in the pelvis or vagina

Problems with sexual intercourse

Leaking urine or sudden urge to empty the bladder

Low backache

Uterus and cervix that bulge into the vaginal opening

Repeated bladder infections

Vaginal bleeding

Increased vaginal discharge

Symptoms may be worse when you stand or sit for a long time. Exercise or lifting may also make symptoms worse.

Signs and tests

Your health care provider will do a pelvic exam. You will be asked to bear down as if you are trying to push out a baby. This shows how far your uterus has dropped.

Uterine prolapse is mild when the cervix
drops into the lower part of the vagina
.

Uterine prolapse is moderate when the cervix drops out of the vaginal opening.

Other things the pelvic exam may show are:

The bladder and front wall of the vagina are bulging into the vagina (cystocele
).

The rectum and back wall of the vagina (rectocele) are bulging into the vagina.

The urethra and bladder are lower in the pelvis than usual.

Treatment

You do not need treatment unless you are bothered by the symptoms.

Many women will get treatment by the time the uterus drops to the opening of the vagina.

LIFESTYLE CHANGES

The following can help you control your symptoms:

Lose weight if you are obese.

Avoid heavy lifting or straining.

Get treated for a chronic cough. If you cough is due to smoking, try to quit.

VAGINAL PESSARY

Your doctor may recommend placing a rubber or plastic donut-shaped device, into the vagina.This is called a pessary. This device holds the uterus in place.

The pessary may be used for short-term or long-term. The device is fitted for your vagina. Some pessaries are similar to a diaphragm used for birth control.

Pessaries must be cleaned regularly. Sometimes they need to be cleaned by the doctor or nurse. Many women can be taught how to insert, clean, and remove a pessary.

Side effects of pessaries include:

Foul smelling discharge from the vagina

Irritation of the lining of the vagina

Ulcers in the vagina

Problems with normal sexual intercourse

SURGERY

Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The type of surgery will depend on:

The severity of the prolapse

The woman’s plans for future pregnancies

The woman’s age, health, and other medical problems

The woman’s desire to retain vaginal function

There are some surgical procedures that can be done without removing the uterus, such as a sacrospinous fixation. This procedure involves using nearby ligaments to support the uterus. Other procedures are also available.

Often, a vaginal hysterectomy
is used to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.

Expectations (prognosis)

Most women with mild uterine prolapse do not have symptoms that require treatment. .

Vaginal pessaries can be effective for many women with uterine prolapse.

Surgery often provides very good results. However, some women may need to have the treatment again in the future.

Complications

Ulceration and infection of the cervix and vaginal walls may occur in severe cases of uterine prolapse.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

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